Youth Medical History and Release Form


 Female
 Male
 5
 6
 7
 8
 9
 10
 11
 12
 Yes
 No
 aspirin
 acetaminophen
 ibuprofen
 antihistamine or decongestant
 motion sickness medication
 laxative or ant-diarrhea medication
 antibacterial or antibiotic ointment
 Yes
 No
 Yes
 No
 

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